Ranking of State Medical Boards' Serious Disciplinary Actions in 2000

April 6, 2001

Based on data we obtained today (April 6, 2001) from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2000 against doctors, Public Citizen's Health Research Group has calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state and compiled a national report ranking state boards by number of serious disciplinary actions taken against doctors in the year 2000 (See Table 1).

Our calculation of rates of serious disciplinary actions (revocations, surrenders, suspensions and probations/restrictions) per 1,000 doctors by state is created by taking the number of such actions (columns A and B from the FSMB data) and dividing it by the American Medical Association data on nonfederal M.Ds as of December 1999 (adding to this the number of osteopathic physicians if the board is a combined M.D./D.O. board) then multiplying the result by 1,000 to get state disciplinary rates per 1000 physicians.

Nationally, there were 2,746 serious disciplinary actions taken by state medical boards in 2000, up slightly from the 2,696 serious actions taken in 1999. However, there were more physicians practicing in 2000 and the rate, per 1000 physicians, was essentially the same in the two years: 3.50 serious actions per 1000 physicians in 1999 and 3.49 in 2000.

State rates ranged from 12.43 serious actions per 1,000 doctors (North Dakota) to 0.85 per 1,000 physicians (Idaho), a 14.6-fold difference between the best and worst states. If all the boards did as good a job as the lowest of the top five boards, the lowest rate for #5, Oklahoma being 6.68 serious disciplinary actions per 1,000 physicians or 0.668 percent, this would amount to a total of 5,255 (0.668 percent of 786,685 non-federal doctors) serious actions a year. This is 1.9 times as many (2,509 more serious actions) than the 2,746 that actually occurred in 2000.

Worst States

those with the lowest rate of serious disciplines

As can be seen in Table 1, the bottom 15 states, those with the lowest serious disciplinary rates in 2000, were, starting with the lowest: Idaho (0.85 per 1,000 physicians), South Dakota (1.24), Hawaii (1.33), Delaware (1.39), Minnesota (1.53), Massachusetts (1.58), Illinois (1.67), Washington (1.78), Montana (1.91), New Mexico (2.13), Maryland (2.21), Nebraska (2.39), Texas (2.42), Kansas (2.53), and West Virginia (2.54). Of the 15 states with the worst serious disciplinary records, eight of the states, Massachusetts, Illinois, Maryland, Washington, Minnesota, Kansas, Hawaii, and Delaware were also in the bottom 15 states in 1999 and 1998 (see Table 2). In 2000, the bottom 24 states all had rates of serious disciplinary action that were one-half or less than the rate of all of the top five states.

These data raise serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians. It is likely that patients are being injured or killed more often in states with poor doctor disciplinary records than in states with consistent top performances.

Best States

those with the highest rates of serious disciplines

Table 1 lists each state's ranking and rate in descending order. The top 10 states, or those with the highest rate of serious disciplinary actions per 1,000 physicians are (in order): North Dakota (12.43 per 1,000 physicians), Alaska (11.47), Kentucky (8.51), Wyoming (8.10), Oklahoma (6.68), Utah (6.27), Arizona (6.18), Ohio (5.89), Georgia (5.35), and New York (5.08). Four of these 10 states (Alaska, Oklahoma, Wyoming, and Ohio) were also in the top 10 in 1998 and 1999 and one state, Alaska, has been in the top 10 for ten straight years. Oklahoma, 5th this year, has been in the top 10 states for nine of the last ten years. Wyoming, 4th this year, has been in the top 10 for eight of the last ten years and Ohio, 8th this year, have been in the top ten for six of the last ten years. (See Table 2)

It is clear that state-by-state performance is spotty. Only two of the nation's 15 largest states, Ohio, and New York, are represented among those 10 states with the highest disciplinary rates. Other large states such as, Michigan and California (14th and 19th respectively in 2000) have shown improvement from 40th and 37th in 1991. But other large states such as Texas, Illinois, and Massachusetts (38th, 44th, and 45th in 2000) have not done very much doctor discipline for many of the last 10 years.

What Makes a Difference?

Boards are likely to be able to do a better job in disciplining physicians if most if not all of the following conditions are true:

Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes)

Adequate staffing

Proactive investigations rather than only following complaints

The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions

Excellent leadership

Independence from state medical societies and other parts of the state government

A reasonable statutory framework for disciplining doctors (preponderance of the evidence rather than beyond reasonable doubt or clear and convincing evidence).

Given the importance of medical boards in protecting patients in a state from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents of those states, most states are not living up to this obligation. Serious attention must be given to finding out which of the above variables are deficient in each state and taking action, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.

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